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PubMed1999

Highlights of the sexual activity of the heterosexual population in the province of Quebec.

OBJECTIVES: To describe and quantify the level of sexual activity of the heterosexually active population of Quebec. METHODS: The data analysed included 2889 heterosexually active individuals aged 15-60 (agemed = 32) from a 1996-7 survey on the sexual lifestyles of the general population of Quebec. Various probability distributions were studied to assess their capacity to describe and quantify the lifetime and yearly numbers of sexual partners of the sampled population. To estimate the annual rates of new partner acquisition, a generalised linear model was fitted to the number of lifetime sexual partners as a function of age, years of sexual activity, and sex. RESULTS: The mean and variance of the number of lifetime sexual partners for men (mean = 11, s2 = 163) is higher than for women (mean = 6, s2 = 72). The negative binomial and lognormal probability distributions give the most adequate fit to the lifetime number of partners for both agglomerated and stratified (by sex and age) data. The estimated annual rates of new partner acquisition provide two important results for prevention: (1) the first year of sexual activity represents the highest annual rate of new partner acquisition independent of age, (2) annual rates of new partner acquisitions increase through mid-life (ages 40-50) combined with a decrease in condom use. CONCLUSION: Problems caused by the use of large categories in the estimation of mean and variance cannot totally be overcome by fitting probability distributions to the empirical data despite good fits. Furthermore, we believe that adequate estimates of the annual rate of new partner acquisition should be a better measure of the risk of HIV infection than the number of partners since the first is a measure of incidence while the second is a measure of prevalence.

Adolescent↗
PubMed1998

Binocular information acquisition and visual memory.

Mechanisms underlying the binocular combination of visual information were investigated within the context of a visual information acquisition theory proposed by Loftus, Busey, and their colleagues (e.g., as described by T.A. Busey & G. R. Loftus, 1994). A central assumption of the theory is that of a sensory threshold, which engenders an information loss such that information processing subsequent to the threshold is assumed to occur only when the magnitude of a sensory representation triggered by the stimulus exceeds the threshold. The presumed sensory threshold may be situated prior to or subsequent to the point at which the information from the two eyes combines. The location of this threshold was investigated in 3 experiments that provided conclusions about the location of the sensory thresholds and the mechanisms of binocular combination. It is concluded that a linear summation mechanism, an independent sampling information acquisition model, and both pre- and postcombinatorial sources of information loss are required to account for the data.

Humans↗
PubMed1996

The effects of active and passive stimulation on chemosensory event-related potentials.

During normal olfaction, stimulation is dependent upon nasal inhalation. When collecting chemosensory event-related potentials (CSERPs), inhalations may produce artifacts such as respiration-related brain potentials that confound interpretation of the data. To avoid this type of artifact, CSERPs have often been collected using stimulation that is independent of respiratory cycle. It is possible, however, that inspirations prime the olfactory tract for odor input, and traditional CSERP data acquisition techniques, obscure this neural preparation. To investigate this question, twelve subjects were tested using two different approaches to stimulation. Odorants (butanol 2% and 4%) were introduced into a warmed and humidified air stream and delivered to one nostril through a cannula. In one condition, subjects mouth-breathed and stimuli occurred asynchronously with respiratory cycle (passive). In the other condition, subjects inhaled through the nose and stimuli were delivered synchronously with nasal inhalations (active). CSERP data were collected from thirty scalp sites for 3 s following stimulation. Data were corrected for eye movements, smoothed, and averaged. Maximal amplitudes for an early negativity (N1) and later positivity (P2) were determined and submitted to separate analyses of variance. These analyses indicated that administration technique interacted with both odor concentration and recording site. Additionally, amplitude of P2 was greater in the passive condition. Such results suggest that the two administration techniques produce different neural processing of olfactory stimuli and that the passive technique may be better suited for determination of the integrity of the olfactory tract for single subjects because of its greater amplitude.

Adolescent↗
PubMed2001

Modulation of cellular iron metabolism by hydrogen peroxide. Effects of H2O2 on the expression and function of iron-responsive element-containing mRNAs in B6 fibroblasts.

Cellular iron uptake and storage are coordinately controlled by binding of iron-regulatory proteins (IRP), IRP1 and IRP2, to iron-responsive elements (IREs) within the mRNAs encoding transferrin receptor (TfR) and ferritin. Under conditions of iron starvation, both IRP1 and IRP2 bind with high affinity to cognate IREs, thus stabilizing TfR and inhibiting translation of ferritin mRNAs. The IRE/IRP regulatory system receives additional input by oxidative stress in the form of H(2)O(2) that leads to rapid activation of IRP1. Here we show that treating murine B6 fibroblasts with a pulse of 100 microm H(2)O(2) for 1 h is sufficient to alter critical parameters of iron homeostasis in a time-dependent manner. First, this stimulus inhibits ferritin synthesis for at least 8 h, leading to a significant (50%) reduction of cellular ferritin content. Second, treatment with H(2)O(2) induces a approximately 4-fold increase in TfR mRNA levels within 2-6 h, and subsequent accumulation of newly synthesized protein after 4 h. This is associated with a profound increase in the cell surface expression of TfR, enhanced binding to fluorescein-tagged transferrin, and stimulation of transferrin-mediated iron uptake into cells. Under these conditions, no significant alterations are observed in the levels of mitochondrial aconitase and the Divalent Metal Transporter DMT1, although both are encoded by two as yet lesser characterized IRE-containing mRNAs. Finally, H(2)O(2)-treated cells display an increased capacity to sequester (59)Fe in ferritin, despite a reduction in the ferritin pool, which results in a rearrangement of (59)Fe intracellular distribution. Our data suggest that H(2)O(2) regulates cellular iron acquisition and intracellular iron distribution by both IRP1-dependent and -independent mechanisms.

Amino Acid Sequence↗
PubMed2006

Gene expression patterns reveal tissue-specific signaling networks controlling programmed cell death and ABA- regulated maturation in developing barley seeds.

Gene expression patterns covering over 10,000 seed-expressed sequences were analyzed by macroarray technology in maternal tissue (mainly pericarp) and filial endosperm and embryo during barley seed development from anthesis until late maturation. Defined sets of genes showing distinct expression patterns characterized both tissue type and major developmental phases. The analysis focused on regulatory networks involved in programmed cell death (PCD) and abscisic acid (ABA)-mediated maturation. These processes were similar in the different tissues, but typically involved the expression of alternative members of a common gene family. The analysis of co-expressed gene sets and the identification of cis regulatory elements in orthologous rice gene 'promoter' regions suggest that PCD in the pericarp is mediated by distinct classes of proteases and is under the hormonal control of both jasmonic acid (JA) and ethylene via ethylene-responsive element binding protein (EREBP) transcription factors (TFs). On the other hand, PCD in endosperm apparently involves only the ethylene pathway, but employs distinct gene family members from those active in the pericarp, and a different set of proteases and TFs. JA biosynthetic genes are hardly activated. Accordingly, JA levels are high in the pericarp but low in the endosperm during middle and late developmental stages. Similarly, genes acting in the deduced ABA biosynthetic pathway and signaling network differ between endosperm and embryo. ABA in the endosperm appears to exert an influence over storage product synthesis via SNF1 kinase. In the embryo, ABA seems to influence the acquisition of desiccation tolerance via ABA response element binding factors, but the data also suggest the existence of an ABA-independent but interactive pathway acting via the dehydration-responsive element binding (DREB) 2A TF.

Abscisic Acid↗
PubMed2003

Effects of rapid detection of bloodstream infections on length of hospitalization and hospital charges.

Current automated continuous-monitoring blood culture systems afford more rapid detection of bacteremia and fungemia than is possible with non-instrument-based manual methods. Use of these systems has not been studied objectively with respect to impact on patient outcomes, including hospital charges and length of hospitalization. We conducted a prospective, two-center study in which the time from the obtainment of the initial positive blood culture until the Gram stain was called was evaluated for 917 cases of bloodstream infection. Factors showing univariate associations with a shorter time to notification included higher body temperature and respiratory rate and higher percentage of immature neutrophils. Multiple linear regression models determined that the primary predictors of both increased microbiology laboratory and total hospital charges for patients with bloodstream infection were nonmicrobiologic and included length of stay and host factors such as the admitting service and underlying illness score. Significant microbiologic predictors of increased charges included the number of blood cultures obtained, nosocomial acquisition, and polymicrobial bloodstream infections. Accelerated failure time regression analysis demonstrated that microbiologic factors, including time until notification, organism group, and nosocomial acquisition, were independently associated with length of hospitalization after bacteremia, as were the factors of admitting service, gender, and age. Our data suggest that an increased time to notification of bloodstream infection is independently associated with increased length of stay. We conclude that the time to notification is an obvious target for efforts to shorten length of stay. The newest generation of automated continuous-monitoring blood culture systems, which shorten the time required to obtain a positive result, should impact length of hospitalization.

Adolescent↗
PubMed2005

Java Web Start based software for automated quantitative nuclear analysis of prostate cancer and benign prostate hyperplasia.

BACKGROUND: Androgen acts via androgen receptor (AR) and accurate measurement of the levels of AR protein expression is critical for prostate research. The expression of AR in paired specimens of benign prostate and prostate cancer from 20 African and 20 Caucasian Americans was compared to demonstrate an application of this system. METHODS: A set of 200 immunopositive and 200 immunonegative nuclei were collected from the images using a macro developed in Image Pro Plus. Linear Discriminant and Logistic Regression analyses were performed on the data to generate classification coefficients. Classification coefficients render the automated image analysis software independent of the type of immunostaining or image acquisition system used. The image analysis software performs local segmentation and uses nuclear shape and size to detect prostatic epithelial nuclei. AR expression is described by (a) percentage of immunopositive nuclei; (b) percentage of immunopositive nuclear area; and (c) intensity of AR expression among immunopositive nuclei or areas. RESULTS: The percent positive nuclei and percent nuclear area were similar by race in both benign prostate hyperplasia and prostate cancer. In prostate cancer epithelial nuclei, African Americans exhibited 38% higher levels of AR immunostaining than Caucasian Americans (two sided Student's t-tests; P < 0.05). Intensity of AR immunostaining was similar between races in benign prostate. CONCLUSION: The differences measured in the intensity of AR expression in prostate cancer were consistent with previous studies. Classification coefficients are required due to non-standardized immunostaining and image collection methods across medical institutions and research laboratories and helps customize the software for the specimen under study. The availability of a free, automated system creates new opportunities for testing, evaluation and use of this image analysis system by many research groups who study nuclear protein expression.

Algorithms↗
PubMedDate not supplied

Effect of two natural light regimes and nutrient addition on the forest herb Begonia decandra (Begoniaceae).

The effect of two natural light-growing conditions (understory versus light gaps) and the interaction with nutrient availability (through fertilization) were studied in the understory herb Begonia decandra, in the Luquillo Experimental Forest in Puerto Rico. Sixteen potted plants obtained from cuttings were randomly chosen and distributed in each of eighth forest environments (four light gaps and four understories), for a total of 128 plants. Fertilizer was applied to half of the plants in each site. After seven months in the two given microenvironments, increased light and fertilization resulted in greater growth and some changes in the biomass allocation patterns. All measured variables responded similarly to reported changes for tree seedlings and saplings from other tropical and subtropical regions. Total growth parameters (height, biomass and leaf area) were very sensitive to increases in the main resource (light). The addition of nutrients was less important in producing changes in the allocation variables (root to shoot ratio, leaf area ratio, and specific leaf mass) under conditions of high light availability. Changes due to nutrient levels were relatively greater on plants grown under under-story conditions. Also, small light differences among sites can cause significant changes in the variables related to total growth. Lastly, plant mortality in the nutrient treatments was found to be independent of mortality in two forest light environments. Some hypotheses about resource acquisition and plant growth are not supported by this data.

Biomass↗
PubMed1989

Neurosurgical stimulation, impedance monitoring and data acquisition system.

We describe the design of a programmable neurosurgical stimulator with impedance monitoring facilities. The computer is used both to control a stimulator and for the storage of various parameters employed in the process. The stimulator is designed to minimize tissue damage by injecting net zero charge; its output is a current, independent of load resistance. By measuring electrode voltage, the load impedance can be calculated. Software is provided in order to log patient data, and trajectory details with reference to coordinates calculated from other imaging systems such as CAT scanners.

Computer Systems↗
PubMed2003

Comparative genomic analyses of the vibrio pathogenicity island and cholera toxin prophage regions in nonepidemic serogroup strains of Vibrio cholerae.

Two major virulence factors are associated with epidemic strains (O1 and O139 serogroups) of Vibrio cholerae: cholera toxin encoded by the ctxAB genes and toxin-coregulated pilus encoded by the tcpA gene. The ctx genes reside in the genome of a filamentous phage (CTXphi), and the tcpA gene resides in a vibrio pathogenicity island (VPI) which has also been proposed to be a filamentous phage designated VPIphi. In order to determine the prevalence of horizontal transfer of VPI and CTXphi among nonepidemic (non-O1 and non-O139 serogroups) V. cholerae, 300 strains of both clinical and environmental origin were screened for the presence of tcpA and ctxAB. In this paper, we present the comparative genetic analyses of 11 nonepidemic serogroup strains which carry the VPI cluster. Seven of the 11 VPI(+) strains have also acquired the CTXphi. Multilocus sequence typing and restriction fragment length polymorphism analyses of the VPI and CTXphi prophage regions revealed that the non-O1 and non-O139 strains were genetically diverse and clustered in lineages distinct from that of the epidemic strains. The left end of the VPI in the non-O1 and non-O139 strains exhibited extensive DNA rearrangements. In addition, several CTXphi prophage types characterized by novel repressor (rstR) and ctxAB genes and VPIs with novel tcpA genes were found in these strains. These data suggest that the potentially pathogenic, nonepidemic, non-O1 and non-O139 strains identified in our study most likely evolved by sequential horizontal acquisition of the VPI and CTXphi independently rather than by exchange of O-antigen biosynthesis regions in an existing epidemic strain.

Amino Acid Sequence↗
PubMedDate not supplied

Web-based telemicroscopy.

By taking advantage of network-based computing and the recent developments in Web interfaces, centralized research facilities housing specialized and unique imaging instruments along with associated high-performance computing can be made available to researchers for use from their own laboratories. In addition to increasing access and utilization of these facilities, operation over the Internet is expected to enhance research by facilitating collaboration between researchers. We describe the implementation of a platform-independent Web-based system written in Java that supplements automated functions with video-guided interactive, collaborative remote control and data acquisition from an intermediate-high-voltage electron microscope.

Academies and Institutes↗
PubMed2002

Emotional changes related to age in rats--a behavioral analysis.

The present study investigated age-related differences in the emotional behavior of rats using factor analysis to identify motivational factors influencing spontaneous behavior in open field with illuminated center (OF), plus maze (EPM) and social interactions test. Animals of the same strain, bred under the same conditions, formed two experimental groups: young adults (YA, N=20) tested at the age of 4 months and old rats (OA, N=16) tested at the age of 24 months. The computer video based tracking system EthoVision was used for automated acquisition and analysis of data. The results of each test were analyzed separately for YA and OA by factor analysis. Two main independent factors emerged from the analysis of OF measures-factor 1, which appeared to reflect motor activity, and factor 2, reflecting anxiety. The measures best reflecting motor activity (distance moved in the peripheral zone) and anxiety (time spent in central zone) decreased significantly with age. Factor analysis for EPM measures revealed, in both groups, three independent factors. In YA, factor 1 reflected motor activity, factor 2-anxiety, in OA measures of anxiety loaded on factor 1, measures of activity on factor 2. Factor 3 in both groups appeared to represent a decision making process. The number of entries to the closed arms declined significantly in OA, showing an age related decrease of motor activity. Also, the ratio of open arms entries in relation to the total number of entries decreased in OA, indicating a higher anxiety level. Three independent factors emerged from the analysis of social interaction measures. The pattern of factor loading was different in young and old animals, although the number and time of social interactions did not show age-related differences. In addition to a decrease of motor activity we conclude that old rats also differ from young animals in emotional and social behavior.

Aggression↗
PubMed2005

Volume regulation in cortical collecting duct cells: role of AQP2.

BACKGROUND INFORMATION: The renal CCD (cortical collecting duct) plays a role in final volume and concentration of urine by a process that is regulated by the antidiuretic hormone, [arginine]vasopressin. This hormone induces an increase in water permeability due to the translocation of AQP2 (aquaporin 2) from the intracellular vesicles to the apical membrane of principal cells. During the transition from antidiuresis to diuresis, CCD cells are exposed to changes in environmental osmolality, and cell-volume regulation may be especially important for the maintenance of intracellular homoeostasis. Despite its importance, cell-volume regulation in CCD cells has not been widely investigated. Moreover, no studies have been carried out till date to evaluate the putative role of AQPs during this process in renal cells. RESULTS: In the present study, we have studied the regulatory cell-volume responses to hypo-osmotic or hyperosmotic challenges in two CCD cell lines: one not expressing AQPs and the other stably transfected with AQP2. We have used a fluorescent probe technique in which the acquisition of single-cell kinetic data can be simultaneously recorded with the intracellular pH. Experiments with hyperosmotic mannitol media demonstrated that, independent of AQP2 expression, CCD cells shrink but fail to show regulatory volume increase, at least under the studied conditions. In contrast, under hypo-osmotic shocks, regulatory volume decrease occurs and the activation of these mechanisms is more rapid in AQP2 transfected cells. This regulatory response takes place in parallel with intracellular acidification, which is faster in cells expressing AQP2. The acidification and the initial regulatory volume decrease response were inhibited by glibenclamide and BaCl2 only in AQP2 cells. CONCLUSIONS: These results suggest that increases in the osmotic water permeability due to the expression of AQP2 are critical for a rapid activation of regulatory volume decrease mechanisms, which would be linked to cystic fibrosis transmembrane conductance regulator and to barium-sensitive potassium channels.

Animals↗
PubMed1995

Accuracy of breath-by-breath analysis of flow-volume loop in identifying sleep-induced flow-limited breathing cycles in sleep apnoea-hypopnoea syndrome.

1. Inspiratory flow limitation is involved in the pathophysiology of sleep-related breathing disorders. Since the definition of flow-limited cycle is based on a dissociation between flow and respiratory efforts, identification of inspiratory flow limitation requires upper airway or intrathoracic pressure measurements. We examined the accuracy of the analysis of the flow-volume loop of a tidal breath in identifying inspiratory flow limitation during sleep in ten patients with a sleep apnoea-hypopnoea syndrome. 2. Measurements were taken during continuous positive airway pressure trials. After data acquisition, the presence of inspiratory flow limitation was identified by the presence of an inspiratory plateau or decrease in inspiratory flow independently of the increase in inspiratory efforts. The flow-volume loop was reconstructed for each breathing cycle by plotting the instantaneous flow and the tidal volume. The instantaneous inspiratory and expiratory flows were measured at 50% of the respective portion of the tidal volume, and a breath-by-breath analysis of the mid-tidal volume-flow ratio (inspiratory/expiratory ratio) was obtained. The analysis of the flow-volume loop was compared with standard inspiratory flow limitation criteria using different values of the inspiratory/expiratory ratio threshold, below which breathing cycles were classified as flow-limited. With a lower limit of the normal inspiratory/expiratory ratio threshold of 0.97, the sensitivity and specificity of the method were both 76%. In each subject, the proportion of breathing cycles identified as flow-progressively decreased with an increasing positive pressure level.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Induction of thymocyte positive selection does not convey immediate resistance to negative selection.

The acquisition of functional competence represents a critical phase during intrathymic development of T cells. Thymocytes reaching this stage represent cells which have been positively selected on the basis of major histocompatibility complex reactivity, but which have also been purged of potentially autoreactive T-cell receptor specificities by negative selection. While the developmental window in which thymocytes are subjected to positive selection is now well defined, the precise developmental timing of negative selection, in relation to positive selection events, is less clear. Moreover, the underlying mechanism allowing single-positive thymocytes to respond to T-cell receptor ligation by activation rather than death, remains controversial. Here we have analysed the developmental timing of negative selection in relation to positive selection, using measurement of thymocyte susceptibility to dendritic cell presentation of the superantigen staphylococcal enterotoxin B (SEB). We show that thymocytes which have received initial positive selection signals, namely CD4+ CD8+ CD69+ thymocytes, like their CD4+ CD8+ CD69minus sign precursors, are susceptible to negative selection, indicating that induction of positive selection does not convey immediate resistance to negative selection. In contrast, newly generated CD4+ CD8minus sign CD69+ cells are not only resistant to deletion by SEB, but respond to SEB-mediated T-cell receptor-ligation by activation, indicating that the acquisition of functional competence occurs at the newly generated CD4+ CD8minus sign CD69+ stage. Finally, by using direct retroviral infection of primary CD4+ CD8+ thymocytes, we also show that Notch-1 activation in CD4+ CD8+ thymocytes does not correlate with, nor convey resistance to superantigen-mediated negative selection. Thus, our data suggest that although Notch-1 has been implicated in resistance to thymocyte apoptosis, the acquisition of resistance to negative selection occurs independently of Notch-1 signalling.

Animals↗
PubMedDate not supplied

Optical imaging of turbid media using independent component analysis: theory and simulation.

A new imaging approach for 3-D localization and characterization of objects in a turbid medium using independent component analysis (ICA) from information theory is developed and demonstrated using simulated data. This approach uses a multisource and multidetector signal acquisition scheme. ICA of the perturbations in the spatial intensity distribution measured on the medium boundary sorts out the embedded objects. The locations and optical characteristics of the embedded objects are obtained from a Green's function analysis based on any appropriate model for light propagation in the background medium. This approach is shown to locate and characterize absorptive and scattering inhomogeneities within highly scattering medium to a high degree of accuracy. In particular, we show this approach can discriminate between absorptive and scattering inhomogeneities, and can locate and characterize complex inhomogeneities, which are both absorptive and scattering. The influence of noise and uncertainty in background absorption or scattering on the performance of this approach is investigated.

Biopolymers↗
PubMed2005

Overexpression of cytochrome P450 1A1 and its novel spliced variant in ovarian cancer cells: alternative subcellular enzyme compartmentation may contribute to carcinogenesis.

Epithelial ovarian cancer derived from the human ovarian surface epithelium (HOSE) is the leading cause of death from gynecologic malignancies among American women. Metabolic activation of endogenous and exogenous chemicals by cytochrome P450 (CYP) class I enzymes has been implicated in its etiology. In this study, we showed overexpression of CYP1A1 mRNA, but not CYP1B1 transcripts, in ovarian cancer cell lines when compared with primary cultures or immortalized HOSE cell lines. Importantly, we identified a novel, enzymatically active, spliced variant of CYP1A1 (CYP1A1v) formed by excision of an 84-bp cryptic intron in exon 2. CYP1A1v is overexpressed in ovarian cancer cell lines and exhibits a unique subcellular distribution restricted to the nucleus and mitochondria, contrary to the endoplasmic reticulum localization of the wild-type enzyme. In concordance, total CYP1A1 activity, as measured by the ethoxyresorufin O-deethylase assay, was detected in mitochondrial, nuclear, and microsomal fractions of ovarian cancer cells but was notably absent in all subcellular fractions of HOSE cells. Immunocytochemistry studies in 30 clinical specimens revealed overexpression of CYP1A1 in various types of ovarian cancers compared with benign epithelia and frequent localization of the enzyme to cancer cell nuclei. Forced expression of CYP1A1wt or CYP1A1v in HOSE cells resulted in nuclear localization of the enzyme and acquisition of anchorage-independent growth, which was further exacerbated following exposure to benzo(a)pyrene or 17beta-estradiol. Collectively, these data provided the first evidence that CYP1A1 overexpression and alternative splicing could contribute to ovarian cancer initiation and progression.

Alternative Splicing↗
PubMed1996

The economics of a pharmacy-based central intravenous additive service for paediatric patients.

This study was designed to compare the costs of a pharmacy-based Central Intravenous Additive Service (CIVAS) with those of traditional ward-based preparation of intravenous doses for a paediatric population. Labour costs were derived from timings of preparation of individual doses in both the pharmacy and ward by an independent observer. The use of disposables and diluents was recorded and their acquisition costs apportioned to the cost of each dose prepared. Data were collected from 20 CIVAS sessions (501 doses) and 26 ward-based sessions (30 doses). In addition, the costs avoided by the use of part vials in CIVAS was calculated. This was derived from a total of 50 CIVAS sessions. Labour, disposable and diluent costs were significantly lower for CIVAS compared with ward-based preparation (p < 0.001). The ratio of costs per dose [in 1994 pounds sterling] between ward and pharmacy was 2.35:1 (2.51 pounds:1.07 pounds). Sensitivity analysis of the best and worst staff mixes in both locations ranged from 2.3:1 to 4.0:1, always in favour of CIVAS. There were considerable costs avoided in CIVAS from the multiple use of vials; the estimated annual sum derived from the study was 44,000 pounds. In addition, CIVAS was less vulnerable to unanticipated interruptions in work flow than ward-based preparation. CIVAS for children was more economical than traditional ward-based preparation, because of a cost-minimisation effect. Sensitivity analysis showed that these advantages were maintained over a full range of skill mixes. Additionally, significant savings accrued from the multiple use of vials in CIVAS.

Catheterization, Central Venous↗